Mental Health Nursing

Question

Task : By week 6 you should be in a group. To complete this task, you and your group will need to do the following:

Hints and tips for assessment one

• Read the case study several times before doing anything else – ensure you have a good understanding of the client’s history, possible contributory factors, family situation, employment, current presentation, actual and potential risks to self, family and others.
• Carefully consider the search terms and keywords in your literature search.
• Use journal search engines such as: Scopus, ProQuest or Google Scholar. With key words / terms such as: mental state examination; low mood; depression in males; post-partum depression for males; mood and new fathers; depression and medical staff; anxiety in males; depression or anxiety among Chinese migrants; Stress Vulnerability Model; mental health recovery.
• Try to have most of your references from research papers or policy papers.
• Websites such as: Department of Health; Mental Health Commission; Reach Out; Beyond Blue; Black Dog can be helpful as long as properly referenced in your work.
• There is no need for an essay introduction nor conclusion in your work for assessment one.
• You are required to use an academic writing style throughout your work using literature to support you.
• Please number each of your answers, 1,2,3, so the marker is clear which of your answers relates to which question.
• Each question is marked out of 10 and each answer should be 500 words. Avoid using 600 words for one answer and 400 words for another question, as this will reduce your opportunity for higher marks.
• Make sure each question relates back to the client in the case study and incorporates literature.
• Your work should extend more than description or discussion but should move towards critical analysis. One way to do this is to compare and contrast the ideas in the literature. For example: what are the similarities and differences from different pieces of research or noted in policy.
• It’s fine to use a few sub-titles if that helps you to structure your work.
• You should have one reference list which includes all the references from the 3 questions.
• An APA reference list must be included with your work. Your work should include at least 10 different pieces of literature, no more than 5 years old unless it is seminal work.
• Ensure you avoid cutting and pasting text. This will result in review under the Misconduct policy. It can also reduce your overall mark of your work.

Question 1

• You are asked to think about the mental health status of the client making reference to the Mental State Examination.
• Make sure you think about the Mental State Examination (MSE) here and not the overall mental health assessment structure. You will learn more about this in session 2. We want you to think about the present state / presentation of the client in terms of the components of the Mental State Examination such as: appearance and behaviours, affect, mood, thought form, thought content, perception, judgement and insight for example.
• We also want to see that you can think about the client’s presentation with reference to the DSM V. You can do this by thinking about the specific criteria for diagnoses. Show that you can consider the criteria and how they may be relevant for this particular client in the case study. For example: you might want to suggest the client has depression or anxiety so show you have considered the criteria for depression or anxiety which are relevant and how.
• We are expecting that you will have more literature other than the MSE and DSM V for question 1. You should also use other research papers.
• It’s a good idea to aim for 250 words for the Mental State Examination (MSE) and 250 words for the DSM V sub section.
• 4 marks MSE, 4 marks DSM V, 2 marks for references)

Question 2

• Asks you to show your understanding, using literature, of the Stress Vulnerability Model. It would be reasonable to use 100 words for this as the maximum marks for this is 2.
• You are also asked to think about 2 contributing factors where you should make reference to the case study and literature.
• You should use 200 words to identify and discuss, critically analyse the literature for each contributing factor.
• A good way to think about contributing factors are possible stressors which could have impacted on how a person thinks, feels and behaves. For example: having a new baby could be a contributory factor as it creates change in the couple’s relationship; may change the time a person has for themselves and their hobbies; may challenge a person’s sense of self; may increase anxiety; lack of sleep as a result of caring for a new baby can result in changes to a person’s energy and mood.
• (2 marks for Stress Vulnerability Model, 3 marks for each contributing factor, 2 marks for references)

Question 3

• Question 3 asks you to show your understanding of the mental health recovery model / theory and to relate the recovery principles of respect, empowerment and hope to the client in the case study.
• Ensure you relate your answer to the client in the case study and include relevant literature.
• Recommended use of words – 125 words for recovery model / theory and 125 words for each of the principles – respect, empowerment and hope.
• To help direct your thoughts for this question, you might want to ask ‘how can the health professional show respect or exercise a respectful to the client in this particular case study and how could this support his recovery?’ You might want to consider how his family can show a respectful attitude towards the client to better support his recovery or how could his employee be respectful give his current situation to support the client. Thinking about the wider community approach to mental health concerns may also be helpful here. i.e. how can the language used by members of the community support his recovery. ie non-stigmatising language. How can a health professional facilitate self-respect for the client?
• You may want to ask these questions in relation to empowerment ie. how can a health profession, family, employer and the wider community offer greater empowerment to the client to support his recovery? How can this be helpful and why?
• Also, how can hope be helpful for the client, particularly given his current presentation and concerns for self and possible self-harm and suicide? How can a family member, employer and community members support greater hope for this client and why?
• (2 marks for recovery orientated mental health theory and practice, 2 marks each for factors, 2 marks for references)

Answer

Answer 1: The mental health condition of the patient is described below-
Mental status examination or MSE is one of the effective assessment process in mental health practice. It helps to observe and describe the mental status of a person in an effective manner. It helps to understand the attitude, thought process, mood and affect, speech, cognition and perception of a person with mental illness (Fernando & Henskens, 2014). In this case it has been found through the mental status examination that, mood and affect of Chung has been affected due to the excessive pressure of work, lack of time for family, inquiry of the drug error and poor health condition (). Tearful eyes, flat mood, minimum eye contact, restricted affect and purposeful speech have been identified during the session of MSE. Concern for his wife’s health condition, long shift in workplace and less time for his wife and new born daughter have made him anxious. Stress due to such situation has affected his physical health as well. Symptoms such as palpation, weight loss, loss of appetite, chest pain and breathlessness have been found. Such poor health condition and mental depression have led to the consequence of sleeplessness. The mental state examination has also indicated that dramatic change in the thought process of the patient has occurred (Wiger & Mooney, 2014). According to the description of the patient, he has started to think himself uselessness due to his mistake in the workplace. Such failure in the professional life and private life has led to the thought of suicide. In this regards he has thought about overdose of medication as well. Such mental condition of the patient has indicated his hopeless and helpless situation.

DSM 5 or Diagnostic and Statistical Manual for mental illness helps to differentiate between different mental disorders. It provides effective diagnostic criteria that helps to identify the mental status of a person (Brown & Barlow, 2014). Chung has been found to be speak purposefully and his affect has become restricted. In addition, lack of interest in eye contact and looking at the floor while speaking have indicated lack of interest in communication. The feelings of guilt and regret due to the drug error in the workplace and providing less time to the family have led to the consequence of depression and anxiety. Such situation has affected his physical health, thus he has been experiencing chest pain, breathlessness and palpitation. Due to the effect of poor mental health his physical health has affected. The DSM 5 has identified the severe health condition of Harriett, wife of Chung, as the cause of his mental distress (American Psychiatric Association, 2013). Furthermore, DSM 5 has identified anxiety as the cause of insomnia for the patient (Brown & Barlow, 2014). It has been found that due to severe anxiety and depression the patient has been thinking about suicide as well. Considering such facts identified by the diagnostic criteria of DSM 5 it can be said that the client has been suffering from anxiety disorder and depression as well (Regier et al., 2013).

Answer 2: Two main factors contributing to the development of the patient’s mental health are as follows-
One of the most effective tools for recognizing the potential factors that are responsible for the mental illness is stress vulnerability model. The contribution of stress in the development of mental disorder has been identified by the stress vulnerability model. The model has differentiated such factors into protective factor, vulnerability factor and environmental factor (Calvete, Orue & Hankin, 2015). In this case, use of stress vulnerability model would help to recognize the main factors that has contributed to the poor mental status of Chung. The stress vulnerability model has considered stress and having new baby as the vulnerability factors for the client (McEwen & Morrison, 2013).

It has been found that, stress occur due to the inability of a person to cope up with his or her thought during the vital time of life (Calvete, Orue & Hankin, 2015). In case of Chung, stress has contributed to his severe mental condition in an effective manner. Excessive pressure from his workplace has been identified as the main cause of his stress. On the other hand, the client’s wife has been suffering from infection in the surgical site and pain as well, since the birth of their daughter. During such vital time he has failed to provide adequate time and care to his wife. Furthermore, the human resource department of the hospital has started an inquiry due to the drug error. He has been experiencing regret and guilt due to such situation. Together such situations have contributed to the development of stress within Chung. Increase in the stress level has led to the development of psychotic symptoms within the client (Chukhraev et al., 2017). Beside the mental health, the increasing stress has affected the physical health of the client as well. Thus, he has been experiencing the thought of heart attack and suicide. Such level of stress has made him hopeless and helpless as well.

Another responsible factor that has contributed to the poor mental contribution of the Chung is having new baby. The incident of having new baby brings dramatic changes in the life of the couple. It changes the lifestyle, hobbies, self-sense, time management and the relationship as well. Such changes sometimes lead to the consequence of anxiety disorder (Thoits, 2013). In case of Chung it has been found that, after giving the birth to the baby girl, Harriett has been suffering from severe infection and pain. In such condition adequate care and support from Chung is expectable. However, due to pressure of the accident and emergency department of the hospital Chung has failed to spend adequate time with his family. He has been experiencing regret and guilt. Such mental condition has affected his mood, thus, tearful eyes, restricted affect, lack of eye contact, purposeful speech and less interest in communication has been found. Such situation has led to severe depression as well. Thus, having new baby can be considered as a responsible factor for the development of mental distress and poor mental health of the client.

Question 3: The recovery of the patient would be facilitated by recovery-oriented practice and with hope, respect and empowerment in the following manner-
Study has revealed that recovery oriented mental health practice is one of the most effective evidence based practice that facilitates the recovery of the patient with mental illness. The principles of recovery oriented practice include uniqueness of individual, real choice, attitudes and rights, dignity and respect, partnership and communication and evaluating recovery. The one dimensional approach of recovery oriented mental health practice focuses on the retaining hope, identify the strength and weakness of the patient and personal autonomy. In this way recovery oriented practice helps to provide a purposeful and meaningful life through inducing positive sense of self (health.gov.au, 2018). Thus, in this case utilising the principles of recovery oriented practice would facilitate the patient and foster the recovery in an effective manner.

Hope is one of the most effective elements that could be used in the treatment of mental disorder. Inducing hope in the mental health recovery encourage the patients to expect that their condition could be improved. Thus, could inspire them to contribute in the recovery process effectively (Slade et al., 2014). In case of Chung, due to the situation of life, depression and excessive stress he has become hopeless. Introducing hope could help to reduce the level of stress, depression and anxiety. Inducing hope in the recovery process would help to improve the mental health by increasing family support. Hope of improvement in the career and future would help the patient to participate effectively in the treatment and could lead to faster recovery (Abraham et al., 2016).

Respect is another vital element that helps to improve the recovery of the patient with poor mental health (Moran & Russo-Netzer, 2016). In case of Chung, he has been experiencing thought of failure in both the professional life and private life. Thus, inducing respect in the recovery process could help the patient to manage his illness in an effective manner. Respect in the workplace could help to improve professional skill thus, could reduce the guilt of drug error. Furthermore, respect from the family for his contribution in providing care to his wife and daughter even after long working shift could help him to get rid of regression of spending less time with family. In this way the patient could establish personal goal and with respectful treatment he could achieve successful health outcomes (Le Boutillier et al., 2015).

Finally it is important to introduce empowerment in the recovery of mental illness. Empowerment needs to be implemented in the individual level and in society as well. Involve in the self-decision, contribution in wider community, self-reliance and dignity are the four important dimensions of including empowerment in recovery (Moran & Russo-Netzer, 2016). Empowerment could help Chung to resolve the issue of powerlessness. Hence, empowerment could help to improve self-determination. Empowerment in the control, influence and level of choice over the events of life could help the client to understand the significance of life and live a meaningful life. Through empowerment the client could establish social networks, thus, could enhance the social support. In this way, empowerment could help Chung to recover from his psychotic disorder (Slade et al., 2014).

References:
Abraham, K. M., Nelson, C. B., Ganoczy, D., Zivin, K., Brandfon, S., Walters, H., … & Valenstein, M. (2016). Psychometric analysis of the Mental Health Recovery Measure in a sample of veterans with depression. Psychological services, 13(2), 193.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Brown, T. A., & Barlow, D. H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5L)-Lifetime Version: Client Interview Schedule 5-Copy Set (Treatments That Work).

Calvete, E., Orue, I., & Hankin, B. L. (2015). A longitudinal test of the vulnerability-stress model with early maladaptive schemas for depressive and social anxiety symptoms in adolescents. Journal of Psychopathology and Behavioral Assessment, 37(1), 85-99.

Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients. Journal of Physical Education and Sport, 17(1), 414.

Fernando, D. I., & Henskens, F. A. (2014, November). A case-based reasoning approach to mental state examination using a similarity measure based on orthogonal vector projection. In Artificial Intelligence (MICAI), 2014 13th Mexican International Conference on (pp. 237-244). IEEE.

health.gov.au (2018). Department of Health | Principles of recovery-oriented mental health practice.. Retrieved from http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri

Le Boutillier, C., Chevalier, A., Lawrence, V., Leamy, M., Bird, V. J., Macpherson, R., … & Slade, M. (2015). Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science, 10(1), 87.

McEwen, B. S., & Morrison, J. H. (2013). The brain on stress: vulnerability and plasticity of the prefrontal cortex over the life course. Neuron, 79(1), 16-29.

Moran, G., & Russo-Netzer, P. (2016). Understanding universal elements in mental health recovery: a cross-examination of peer providers and a non-clinical sample. Qualitative health research, 26(2), 273-287.

Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. American journal of psychiatry, 170(1), 59-70.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.

Thoits, P. A. (2013). Self, identity, stress, and mental health. In Handbook of the sociology of mental health (pp. 357-377). Springer, Dordrecht.

Wiger, D. E., & Mooney, N. B. (2014). Mental Status Exam. The Encyclopedia of Clinical Psychology, 1-5.